Benign prostatic hyperplasia علاج

Benign prostatic hyperplasia By Dr.karar hasan ali  Pathophysiology  The prostate is a part glandular, part fibromuscular structure about the size of a walnut that surrounds the first part of the male urethra at the base of the bladder. In simple terms, the prostate can be divide...

Benign prostatic hyperplasia By Dr.karar hasan ali  Pathophysiology  The prostate is a part glandular, part fibromuscular structure about the size of a walnut that surrounds the first part of the male urethra at the base of the bladder. In simple terms, the prostate can be divided into a lobular inner zone encapsulated by an external layer. The inner zone is where benign hypertrophic changes are generally found, whereas most malignant changes ‫ وﺟﺰء ﻣﻦ ﺑﻨﻴﺔ ﻟﻴﻔﻴﺔ ﻋﻀﻠﻴﺔ ﺑﺤﺠﻢ اﻟﺠﻮز اﻟﺬي ﻳﺤﻴﻂ ﺑﺎﻟﺠﺰء الأول ﻣﻦ ﻣﺠﺮى‬،‫اﻟﺒﺮوﺳﺘﺎﺗﺎ ﻋﺒﺎرة ﻋﻦ ﺟﺰء ﻏﺪي‬ originate in the peripheral zone. ‫ ﻳﻤﻜﻦ ﺗﻘﺴﻴﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ إﻟﻰ ﻣﻨﻄﻘﺔ داﺧﻠﻴﺔ ﻓﺼﻴﺔ ﻣﻐﻠﻔﺔ‬،‫ ﺑﻌﺒﺎرات ﺑﺴﻴﻄﺔ‬.‫اﻟﺒﻮل اﻟﺬﻛﺮي ﻋﻨﺪ ﻗﺎﻋﺪة اﻟﻤﺜﺎﻧﺔ‬ ‫ ﻓﻲ‬،‫ اﻟﻤﻨﻄﻘﺔ اﻟﺪاﺧﻠﻴﺔ ﻫﻲ اﻟﻤﻜﺎن اﻟﺬي ﺗﻮﺟﺪ ﻓﻴﻪ اﻟﺘﻐﻴﺮات اﻟﻀﺨﺎﻣﻴﺔ اﻟﺤﻤﻴﺪة ﺑﺸﻜﻞ ﻋﺎم‬.‫ﺑﻄﺒﻘﺔ ﺧﺎرﺟﻴﺔ‬  Prostatic hypertrophy is directly ‫ﺔ‬related ‫ﺸﺄ ﻓﻲ اﻟﻤﻨﻄﻘﺔ اﻟﻄﺮﻓﻴ‬to‫ﺨﺒﻴﺜﺔ ﺗﻨ‬the ageing ‫ﻢ اﻟﺘﻐﻴﺮات اﻟ‬‫ﺣﻴﻦ أن ﻣﻌﻈ‬. process and to hormone activity. Within the prostate, testosterone is converted by 5α-reductase to dihydrotestosterone (DHT). DHT is five times more potent than testosterone and is responsible for stimulating growth factors that influence cell division leading to prostatic ‫ ﻳﺘﻢ‬،‫ داﺧﻞ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬.‫ﻳﺮﺗﺒﻂ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ ارﺗﺒﺎﻃﺎ ﻣﺒﺎشرا ﺑﻌﻤﻠﻴﺔ اﻟﺸﻴﺨﻮﺧﺔ واﻟﻨﺸﺎط اﻟﻬﺮﻣﻮﻧﻲ‬ hyperplasia and enlargement. 5 ‫ﺗﺤﻮﻳﻞ اﻟﺘﺴﺘﻮﺳﺘﻴﺮون ﺑﻮاﺳﻄﺔ‬α-reductase ‫ إﻟﻰ‬dihydrotestosterone (DHT). DHT ‫أﻗﻮى ﺑﺨﻤﺲ‬ ‫ﻣﺮات ﻣﻦ ﻫﺮﻣﻮن اﻟﺘﺴﺘﻮﺳﺘﻴﺮون وﻫﻮ ﻣﺴﺆول ﻋﻦ ﺗﺤﻔﻴﺰ ﻋﻮاﻣﻞ اﻟﻨﻤﻮ اﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻰ اﻧﻘﺴﺎم اﻟﺨﻞاﻳﺎ‬  As the prostate enlarges, it can ‫وﺗﻀﺨﻤﻬﺎ‬compress ‫ﻳﺆدي إﻟﻰ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬the ‫ﻣﻤﺎ‬. urethra and this, together with increased adrenergic tone, can lead to bladder outflow obstruction (BOO) and lower urinary tract symptoms (LUTSs). Therefore, the term BPH includes benign prostatic enlargement (BPE), the clinical features associated with urinary obstruction and LUTSs..LUTSs‫و‬ ‫( وأﻋﺮاض‬BOO) ‫ ﯾﻤﻜﻦ أن ﯾﺆدي إﻟﻰ اﻧﺴﺪاد ﺗﺪﻓﻖ اﻟﻤﺜﺎﻧﺔ‬،‫ إﻟﻰ ﺟﺎﻧﺐ زﯾﺎدة ﻟﮭﺠﺔ اﻷدرﯾﻨﺎﻟﯿﺔ‬،‫ ﯾﻤﻜﻦ أن ﺗﻀﻐﻂ ﻋﻠﻰ ﻣﺠﺮى اﻟﺒﻮل وھﺬا‬،‫ﻣﻊ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬ ‫ واﻟﺴﻤﺎت اﻟﺴﺮﯾﺮﯾﺔ اﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻧﺴﺪاد اﻟﺒﻮل‬،(BPE) ‫ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ‬BPH ‫ ﯾﺘﻀﻤﻦ ﻣﺼﻄﻠﺢ‬،‫ ﻟﺬﻟﻚ‬.(LUTSs) ‫اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ اﻟﺴﻔﻠﯿﺔ‬  Symptoms  Men with BPH can develop bothersome LUTSs that can impact negatively on their quality of life. It is important to emphasise that not all men who experience LUTSs have BPH. ‫ ﻣﺰﻋﺠﺔ ﯾﻤﻜﻦ أن ﺗﺆﺛﺮ ﺳﻠﺒﺎ ﻋﻠﻰ ﻧﻮﻋﯿﺔ‬LUTSs ‫ﯾﻤﻜﻦ ﻟﻠﺮﺟﺎل اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﻲ ﺗﻄﻮﯾﺮ‬.‫ ﻟﺪﯾﮭﻢ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ‬LUTSs ‫ ﻣﻦ اﻟﻤﮭﻢ اﻟﺘﺄﻛﯿﺪ ﻋﻠﻰ أﻧﮫ ﻟﯿﺲ ﻛﻞ اﻟﺮﺟﺎل اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ‬.‫ﺣﯿﺎﺗﮭﻢ‬  LUTSs can have different aetiologies including bladder cancer or stones, urinary tract infection (UTI) or urethral stricture. Furthermore, a histological diagnosis of BPH does not mean the patient will suffer from LUTSs..‫( أو ﺗﻀﯿﻖ ﻣﺠﺮى اﻟﺒﻮل‬UTI) ‫ ﻣﺴﺒﺒﺎت ﻣﺨﺘﻠﻔﺔ ﺑﻤﺎ ﻓﻲ ذﻟﻚ ﺳﺮطﺎن اﻟﻤﺜﺎﻧﺔ أو اﻟﺤﺠﺎرة أو ﻋﺪوى اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ‬LUTSs ‫ﯾﻤﻜﻦ أن ﯾﻜﻮن ل‬.LUTSs ‫ ﻓﺈن اﻟﺘﺸﺨﯿﺺ اﻟﻨﺴﯿﺠﻲ ﻟﺘﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ ﻻ ﯾﻌﻨﻲ أن اﻟﻤﺮﯾﺾ ﺳﯿﻌﺎﻧﻲ ﻣﻦ‬،‫ﻋﻼوة ﻋﻠﻰ ذﻟﻚ‬  LUTSs can be divided into symptoms of failure of urine storage (irritative) and those caused by failure to empty the bladder (obstructive or voiding).  Irritative symptoms.(‫ إﻟﻰ أﻋﺮاض ﻓﺸﻞ ﺗﺨﺰﯾﻦ اﻟﺒﻮل )اﻟﺘﮭﯿﺞ( وﺗﻠﻚ اﻟﻨﺎﺟﻤﺔ ﻋﻦ اﻟﻔﺸﻞ ﻓﻲ إﻓﺮاغ اﻟﻤﺜﺎﻧﺔ )اﻧﺴﺪاد أو إﻓﺮاغ‬LUTSs ‫ﯾﻤﻜﻦ ﺗﻘﺴﯿﻢ‬  Frequency ‫اﻷﻋﺮاض اﻟﻤﮭﯿﺠﺔ‬ ‫ اﻟﺘﺮدد‬  Nocturia ‫ اﻟﺘﺒﺎل اﻟﻠﯿﻠﻲ‬  Urgency and urge incontinence ‫ اﻻﺳﺘﻌﺠﺎل وﺳﻠﺲ اﻟﺒﻮل‬  Obstructive symptoms ‫أﻋﺮاض اﻻﻧﺴﺪاد‬  Poor urinary flow ‫ ﺿﻌﻒ ﺗﺪﻓﻖ اﻟﺒﻮل‬  Hesitancy in initiation of micturition ‫اﻟﺘﺮدد ﻓﻲ ﺑﺪء اﻟﺘﺒﻮل‬  Post-micturition dribble ‫اﻟﻤﺮاوﻏﺔ ﺑﻌﺪ اﻟﺘﺒﻮل‬  Sensation of incomplete emptying ‫اﻹﺣﺴﺎس ﺑﺎﻹﻓﺮاغ ﻏﯿﺮ اﻟﻜﺎﻣﻞ‬  Occasional acute retention of urine requiring emergency treatment ‫اﺣﺘﺒﺎس ﺣﺎد ﻓﻲ ﺑﻌﺾ اﻷﺣﯿﺎن ﻟﻠﺒﻮل ﯾﺘﻄﻠﺐ ﻋﻼﺟﺎ طﺎرﺋﺎ‬  Treatment.‫ ﻋﺎﻣﺎ ﺑﻌﺾ أﻋﺮاض ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ‬50 ‫ﯾﻈﮭﺮ ﻣﻌﻈﻢ اﻟﺮﺟﺎل اﻟﺬﯾﻦ ﺗﺰﯾﺪ أﻋﻤﺎرھﻢ ﻋﻦ‬ ‫ﺗﺸﻤﻞ ﻣﺠﻤﻮﻋﺔ ﺧﯿﺎرات اﻟﻌﻼج ﻹدارة ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ اﻻﻧﺘﻈﺎر اﻟﯿﻘﻆ واﻟﻌﻼﺟﺎت اﻟﻄﺒﯿﺔ‬.‫ ﻓﺈن اﻟﻘﻀﯿﺔ اﻟﺮﺋﯿﺴﯿﺔ ھﻲ ﺗﺤﺪﯾﺪ ﻣﻦ ﯾﺠﺐ ﻋﻼﺟﮫ وﻣﺘﻰ‬،‫ ﻟﺬﻟﻚ‬.‫واﻟﺘﺪﺧﻼت اﻟﺠﺮاﺣﯿﺔ‬  Most men over the age of 50 years exhibit some of the symptoms of BPH. The range of treatment options for the management of BPH includes watchful waiting, medical therapies and surgical interventions. The key issue, therefore, is deciding who should be treated and when.  Therapeutic management  The principal treatment options are α-adrenoceptor blocking drugs, 5α-reductase inhibitors and combination therapy. Phytotherapy is also used in the management of BPH, although the benefits remain unproven..‫واﻟﻌﻼج اﻟﻤﺮﻛﺐ‬ α- ‫ﺧﯿﺎرات اﻟﻌﻼج اﻟﺮﺋﯿﺴﯿﺔ ھﻲ أدوﯾﺔ ﺣﺠﺐ ﻣﺴﺘﻘﺒﻼت‬ 5α-reductase ‫ وﻣﺜﺒﻄﺎت‬adrenoceptor ،‫ﯾﺴﺘﺨﺪم اﻟﻌﻼج ﺑﺎﻟﻨﺒﺎﺗﺎت أﯾﻀﺎ ﻓﻲ إدارة ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ‬  α-Adrenoceptor blocking drugs.‫ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن اﻟﻔﻮاﺋﺪ ﻻ ﺗﺰال ﻏﯿﺮ ﻣﺜﺒﺘﺔ‬  In the prostate, α1 -receptors predominate and mediate the contraction of the gland's smooth muscle. At least three subtypes of this receptor exist (α1A, α1B and α1D). The α1A is thought to be the dominant receptor in the prostate, although its role clinically has still to be confirmed. This increase in sympathetic tone is potentially reversible by α- adrenoceptor antagonists. ‫اﻷﻗﻞ ﻣﻦﯾﺘﻌﯿﻦھﺬاﺗﺄﻛﯿﺪ‬ ‫ ﯾﻮﺟﺪ ﺛﻼﺛﺔ أﻧﻮاع ﻓﺮﻋﯿﺔ ﻋﻠﻰ‬.‫ وﺗﺘﻮﺳﻂ ﻓﻲ ﺗﻘﻠﺺ اﻟﻌﻀﻼت اﻟﻤﻠﺴﺎء ﻟﻠﻐﺪة‬α1 ‫ ﺗﺴﻮد ﻣﺴﺘﻘﺒﻼت‬،‫ﻓﻲ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬ ‫ ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أﻧﮫ ﻻ ﯾﺰال‬،‫ ھﻮ اﻟﻤﺴﺘﻘﺒﻞ اﻟﻤﮭﯿﻤﻦ ﻓﻲ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬α1A ‫ ﯾﻌﺘﻘﺪ أن‬.(α1D‫ و‬α1B‫ و‬α1A) ‫اﻟﻤﺴﺘﻘﺒﻞ‬.αadrenore ‫ ﻣﻦ اﻟﻤﺤﺘﻤﻞ أن ﺗﻜﻮن ھﺬه اﻟﺰﯾﺎدة ﻓﻲ اﻟﻨﻐﻤﺔ اﻟﻮدﯾﺔ ﻗﺎﺑﻠﺔ ﻟﻠﻌﻜﺲ ﺑﻮاﺳﻄﺔ ﻣﻀﺎدات ﻣﺴﺘﻘﺒﻼت‬.‫دوره ﺳﺮﯾﺮﯾﺎ‬  In general, all the agents are considered to produce similar clinical improvements of LUTSs and urinary flow..‫ وﺗﺪﻓﻖ اﻟﺒﻮل‬LUTSs ‫ ﺗﻌﺘﺒﺮ ﺟﻤﯿﻊ اﻟﻌﻮاﻣﻞ ﺗﻨﺘﺞ ﺗﺤﺴﯿﻨﺎت ﺳﺮﯾﺮﯾﺔ ﻣﻤﺎﺛﻠﺔ ل‬،‫ﺑﺸﻜﻞ ﻋﺎم‬  Benefits can be seen usually within the first few days of therapy and can be maintained in the long-term..‫ﯾﻤﻜﻦ رؤﯾﺔ اﻟﻔﻮاﺋﺪ ﻋﺎدة ﺧﻼل اﻷﯾﺎم اﻟﻘﻠﯿﻠﺔ اﻷوﻟﻰ ﻣﻦ اﻟﻌﻼج وﯾﻤﻜﻦ اﻟﺤﻔﺎظ ﻋﻠﯿﮭﺎ ﻋﻠﻰ اﻟﻤﺪى اﻟﻄﻮﯾﻞ‬  α-Adrenoceptor antagonists also have a comparable side-effect profile, which includes postural hypotension, dizziness, fatigue, headache, drowsiness, nasal congestion and ejaculatory dysfunction. ‫ واﻟﺬي ﯾﺘﻀﻤﻦ اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم‬،‫ ﻟﮭﺎ أﯾﻀﺎ ﻣﻠﻒ ﺟﺎﻧﺒﻲ ﻣﻤﺎﺛﻞ‬α-Adrenore ‫ﻣﻀﺎدات ﻣﺴﺘﻘﺒﻼت‬.‫اﻟﻮﺿﻌﻲ واﻟﺪوﺧﺔ واﻟﺘﻌﺐ واﻟﺼﺪاع واﻟﻨﻌﺎس واﺣﺘﻘﺎن اﻷﻧﻒ واﺧﺘﻼل وظﯿﻔﻲ ﻓﻲ اﻟﻘﺬف‬  Patients with BPH frequently experience erectile and ejaculatory dysfunction..‫ﻏﺎﻟﺒﺎ ﻣﺎ ﯾﻌﺎﻧﻲ اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ ﻣﻦ ﺿﻌﻒ اﻻﻧﺘﺼﺎب واﻟﻘﺬف‬  The treatment of BPH should also aim to improve sexual function. However, the effect of α1 - adrenoceptor antagonists on male sexual function is variable and influenced by the choice of agent and patient characteristics ‫ﻣﻀﺎدات‬ ‫ ﻓﺈن ﺗﺄﺛﯿﺮ‬،‫ وﻣﻊ ذﻟﻚ‬.‫ﯾﺠﺐ أن ﯾﮭﺪف ﻋﻼج ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ أﯾﻀﺎ إﻟﻰ ﺗﺤﺴﯿﻦ اﻟﻮظﯿﻔﺔ اﻟﺠﻨﺴﯿﺔ‬ ‫ ﻋﻠﻰ اﻟﻮظﯿﻔﺔ اﻟﺠﻨﺴﯿﺔ ﻟﻠﺬﻛﻮر ﻣﺘﻐﯿﺮ وﯾﺘﺄﺛﺮ ﺑﺎﺧﺘﯿﺎر ﺧﺼﺎﺋﺺ اﻟﻌﺎﻣﻞ واﻟﻤﺮﯾﺾ‬α1 ‫ﻣﺴﺘﻘﺒﻼت اﻟﻜﻈﺮ‬  Prazosin.  Prazosin was the first α1 -blocker used to relieve the symptoms of BPH but it lacks relative selectivity for α1A receptors and has been associated with many adverse affects such as drowsiness, weakness, headache and postural hypotension (especially after the first dose). α1A ‫ ﯾﺴﺘﺨﺪم ﻟﺘﺨﻔﯿﻒ أﻋﺮاض ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ وﻟﻜﻨﮫ ﯾﻔﺘﻘﺮ إﻟﻰ اﻻﻧﺘﻘﺎﺋﯿﺔ اﻟﻨﺴﺒﯿﺔ ﻟﻤﺴﺘﻘﺒﻼت‬α1 ‫ﻛﺎن ﺑﺮازوﺳﯿﻦ أول ﻣﺎﻧﻊ‬  Terazosin..(‫وﻗﺪ ارﺗﺒﻂ ﺑﺎﻟﻌﺪﯾﺪ ﻣﻦ اﻵﺛﺎر اﻟﺴﻠﺒﯿﺔ ﻣﺜﻞ اﻟﻨﻌﺎس واﻟﻀﻌﻒ واﻟﺼﺪاع واﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم اﻟﻮﺿﻌﻲ )ﺧﺎﺻﺔ ﺑﻌﺪ اﻟﺠﺮﻋﺔ اﻷوﻟﻰ‬  Terazosin was the first in the category to appear in controlled trials aimed at evaluating the efficacy and safety profile of long acting α1 -blockers in the management of BPH. ‫ﻛﺎن ﺗﯿﺮازوﺳﯿﻦ ھﻮ اﻷول ﻓﻲ اﻟﻔﺌﺔ اﻟﺬي ﯾﻈﮭﺮ ﻓﻲ اﻟﺘﺠﺎرب اﻟﺨﺎﺿﻌﺔ ﻟﻠﺮﻗﺎﺑﺔ اﻟﺘﻲ ﺗﮭﺪف إﻟﻰ ﺗﻘﯿﯿﻢ‬.BPH ‫ طﻮﯾﻠﺔ اﻟﻤﻔﻌﻮل ﻓﻲ إدارة‬α1 ‫ﻓﻌﺎﻟﯿﺔ وﺳﻼﻣﺔ ﺣﺎﺻﺮات‬  Efficacy is dose dependant and dose titration is necessary, as terazosin can cause postural hypotension. Adverse effects, although generally mild, occur more frequently than with other α1 -adrenoceptor antagonists, resulting in up to a fourfold increase in treatment discontinuation..‫اﻟﻮﺿﻌﻲ‬ ‫ ﻷن ﺗﯿﺮازوﺳﯿﻦ ﯾﻤﻜﻦ أن ﯾﺴﺒﺐ اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم‬،‫ﺗﻌﺘﻤﺪ اﻟﻔﻌﺎﻟﯿﺔ ﻋﻠﻰ اﻟﺠﺮﻋﺔ وﻣﻌﺎﯾﺮة اﻟﺠﺮﻋﺔ ﺿﺮورﯾﺔ‬ ،‫ ﺑﺸﻜﻞ ﻣﺘﻜﺮر أﻛﺜﺮ ﻣﻦ ﻣﻀﺎدات ﻣﺴﺘﻘﺒﻼت اﻷدرﯾﻨﺎﻟﯿﺔ اﻷﺧﺮى‬،‫ ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أﻧﮭﺎ ﺧﻔﯿﻔﺔ ﺑﺸﻜﻞ ﻋﺎم‬،‫ﺗﺤﺪث اﻵﺛﺎر اﻟﻀﺎرة‬.‫ﻣﻤﺎ ﯾﺆدي إﻟﻰ زﯾﺎدة ﺗﺼﻞ إﻟﻰ أرﺑﻌﺔ أﺿﻌﺎف ﻓﻲ اﻟﺘﻮﻗﻒ ﻋﻦ اﻟﻌﻼج‬ Doxazosin.  Doxazosin has a long half-life of about 22h, which allows for once-daily dosing. When starting treatment, dose titration is recommended to limit postural hypotension. There would appear to be no significant difference in symptom score regardless of whether the standard or controlledrelease preparation is used. ‫ ﻋﻨﺪ ﺑﺪء‬.‫ ﻣﻤﺎ ﯾﺴﻤﺢ ﺑﺎﻟﺠﺮﻋﺎت ﻣﺮة واﺣﺪة ﯾﻮﻣﯿﺎ‬،‫ ﺳﺎﻋﺔ‬22 ‫ﯾﺒﻠﻎ ﻋﻤﺮ اﻟﻨﺼﻒ اﻟﻄﻮﯾﻞ ﻟﻠﺪوﻛﺴﺎزوﺳﯿﻦ ﺣﻮاﻟﻲ‬ ‫ ﯾﺒﺪو أﻧﮫ ﻻ ﯾﻮﺟﺪ ﻓﺮق ﻛﺒﯿﺮ ﻓﻲ درﺟﺔ‬.‫ ﯾﻮﺻﻰ ﺑﻤﻌﺎﯾﺮة اﻟﺠﺮﻋﺔ ﻟﻠﺤﺪ ﻣﻦ اﻧﺨﻔﺎض ﺿﻐﻂ اﻟﺪم اﻟﻮﺿﻌﻲ‬،‫اﻟﻌﻼج‬.‫اﻷﻋﺮاض ﺑﻐﺾ اﻟﻨﻈﺮ ﻋﻤﺎ إذا ﻛﺎن ﯾﺘﻢ اﺳﺘﺨﺪام إﻋﺪاد اﻹﺻﺪار اﻟﻘﯿﺎﺳﻲ أو اﻟﺨﺎﺿﻊ ﻟﻠﺮﻗﺎﺑﺔ‬  Tamsulosin.  Tamsulosin is a selective inhibitor of the α1Aand α1B-adrenoceptor. It has an elimination half-life of about 13h and is available as a prolonged release formulation that allows once-daily dosing. There is no requirement to titrate the dose upward when initiating treatment. Although the side effect profile of tamsulosin is similar to other α1 -adrenoceptor antagonists, it is normally ‫ ﻻ‬.‫ ﺳﺎﻋﺔ وھﻮ ﻣﺘﺎح ﻛﺘﺮﻛﯿﺒﺔ إطﻼق طﻮﯾﻠﺔ ﺗﺴﻤﺢ ﺑﺎﻟﺠﺮﻋﺎت ﻣﺮة واﺣﺪة ﯾﻮﻣﯿﺎ‬13 ‫ ﯾﺒﻠﻎ ﻋﻤﺮ اﻟﻨﺼﻒ ﻟﻠﺘﺨﻠﺺ ﺣﻮاﻟﻲ‬.α1Aand α1B ‫ﺗﺎﻣﺴﻮﻟﻮﺳﯿﻦ ھﻮ ﻣﺜﺒﻂ اﻧﺘﻘﺎﺋﻲ ﻟﻤﺴﺘﻘﺒﻼت اﻷدرﯾﻨﺎﻟﯿﺔ‬ well tolerated.‫ﯾﻜﻮن‬ ‫ إﻻ أﻧﮫ ﻋﺎدة ﻣﺎ‬،α1 ‫ ﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أن ﻣﻠﻒ ﺗﻌﺮﯾﻒ اﻵﺛﺎر اﻟﺠﺎﻧﺒﯿﺔ ﻟﻠﺘﺎﻣﺴﻮﻟﻮﺳﯿﻦ ﻣﺸﺎﺑﮫ ﻟﻤﻀﺎدات ﻣﺴﺘﻘﺒﻼت اﻷدرﯾﻨﺎﻟﯿﺔ اﻷﺧﺮى‬.‫ﯾﻮﺟﺪ ﺷﺮط ﻟﻤﻌﺎﯾﺮة اﻟﺠﺮﻋﺔ إﻟﻰ اﻷﻋﻠﻰ ﻋﻨﺪ ﺑﺪء اﻟﻌﻼج‬.‫ﺟﯿﺪ اﻟﺘﺤﻤﻞ‬  Intraoperative floppy iris syndrome (IFIS) has been reported during cataract surgery in men treated with tamsulosin, as it is highly selective to iris dilator muscle. IFIS can lead to complications and poor outcomes during cataract surgery. As a result, it is essential that patients inform their cataract surgeon that they are taking tamsulosin during the pre-operative assessment. It has been recommended to avoid starting treatment and to discontinue treatment with tamsulosin 1–2 weeks before cataract surgery. ‫ ﻷﻧﮭﺎ اﻧﺘﻘﺎﺋﯿﺔ ﻟﻠﻐﺎﯾﺔ ﻟﻌﻀﻠﺔ ﺗﻤﺪد‬،‫( أﺛﻨﺎء ﺟﺮاﺣﺔ اﻟﺴﺎد ﻟﺪى اﻟﺮﺟﺎل اﻟﺬﯾﻦ ﻋﻮﻟﺠﻮا ﺑﺎﻟﺘﺎﻣﺴﻮﻟﻮﺳﯿﻦ‬IFIS) ‫ﺗﻢ اﻹﺑﻼغ ﻋﻦ ﻣﺘﻼزﻣﺔ اﻟﻘﺰﺣﯿﺔ اﻟﻤﺮﻧﺔ أﺛﻨﺎء اﻟﺠﺮاﺣﺔ‬ ‫ ﻣﻦ اﻟﻀﺮوري أن ﯾﺒﻠﻎ اﻟﻤﺮﺿﻰ ﺟﺮاح اﻟﺴﺎد ﺑﺄﻧﮭﻢ ﯾﺘﻨﺎوﻟﻮن‬،‫ ﻧﺘﯿﺠﺔ ﻟﺬﻟﻚ‬.‫ إﻟﻰ ﻣﻀﺎﻋﻔﺎت وﻧﺘﺎﺋﺞ ﺳﯿﺌﺔ أﺛﻨﺎء ﺟﺮاﺣﺔ اﻟﺴﺎد‬IFIS ‫ ﯾﻤﻜﻦ أن ﯾﺆدي‬.‫اﻟﻘﺰﺣﯿﺔ‬.‫ ﺗﻢ اﻟﺘﻮﺻﯿﺔ ﺑﺘﺠﻨﺐ ﺑﺪء اﻟﻌﻼج واﻟﺘﻮﻗﻒ ﻋﻦ اﻟﻌﻼج ﺑﺎﺳﺘﺨﺪام ﺗﺎﻣﺴﻮﻟﻮﺳﯿﻦ ﻗﺒﻞ أﺳﺒﻮع أو أﺳﺒﻮﻋﯿﻦ ﻣﻦ ﺟﺮاﺣﺔ اﻟﺴﺎد‬.‫ﺗﺎﻣﺴﻮﻟﻮﺳﯿﻦ أﺛﻨﺎء ﺗﻘﯿﯿﻢ ﻣﺎ ﻗﺒﻞ اﻟﺠﺮاﺣﺔ‬  Alfuzosin.  Alfuzosin displays a higher selectivity for the prostate compared with tamsulosin or doxazosin. It has a half-life of 5h, but it is available as a once-daily formulation. It has a rapid onset of action and good tolerability. It reduces the overall clinical progression of BPH and it appears to have a sustained beneficial effect on quality of life. ‫ﻟﺪﯾﮭﺎ‬.‫ وﻟﻜﻨﮫ ﻣﺘﺎح ﻛﺘﺮﻛﯿﺒﺔ ﻣﺮة واﺣﺪة ﯾﻮﻣﯿﺎ‬،‫ ﺳﺎﻋﺎت‬5 ‫ ﯾﺒﻠﻎ ﻋﻤﺮه اﻟﻨﺼﻒ‬.‫ﯾﻈﮭﺮ أﻟﻔﻮزوﺳﯿﻦ اﻧﺘﻘﺎﺋﯿﺔ أﻋﻠﻰ ﻟﻠﺒﺮوﺳﺘﺎﺗﺎ ﻣﻘﺎرﻧﺔ ﺑﺘﺎﻣﺴﻮﻟﻮﺳﯿﻦ أو دوﻛﺴﺎزوﺳﯿﻦ‬.‫ إﻧﮫ ﯾﻘﻠﻞ ﻣﻦ اﻟﺘﻘﺪم اﻟﺴﺮﯾﺮي اﻟﻌﺎم ﻟﺘﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ وﯾﺒﺪو أن ﻟﮫ ﺗﺄﺛﯿﺮا ﻣﻔﯿﺪا ﻣﺴﺘﺪاﻣﺎ ﻋﻠﻰ ﻧﻮﻋﯿﺔ اﻟﺤﯿﺎة‬.‫ﺑﺪاﯾﺔ ﺳﺮﯾﻌﺔ ﻟﻠﻌﻤﻞ وﻗﺎﺑﻠﯿﺔ ﺗﺤﻤﻞ ﺟﯿﺪة‬  Alfuzosin has the least effect on ejaculatory function. Alfuzosin should not be co-administered with potent inhibitors of cytochrome P450 3A4 such as itraconazole, ketoconazole and ritonavir, since this can lead to a several fold increase to exposure in alfuzosin. ‫ﻗﻮﯾﺔ‬ ‫ ﻻ ﯾﻨﺒﻐﻲ إﻋﻄﺎء أﻟﻔﻮزوﺳﯿﻦ ﻣﻊ ﻣﺜﺒﻄﺎت‬.‫أﻟﻔﻮزوﺳﯿﻦ ﻟﮫ أﻗﻞ ﺗﺄﺛﯿﺮ ﻋﻠﻰ وظﯿﻔﺔ اﻟﻘﺬف‬ ‫ ﻷن ھﺬا ﯾﻤﻜﻦ أن ﯾﺆدي‬،‫ ﻣﺜﻞ إﯾﺘﺮاﻛﻮﻧﺎزول واﻟﻜﯿﺘﻮﻛﻮﻧﺎزول ورﯾﺘﻮﻧﺎﻓﯿﺮ‬P450 3A4 ‫ﻟﻠﺴﯿﺘﻮﻛﺮوم‬.‫إﻟﻰ زﯾﺎدة ﻋﺪة أﺿﻌﺎف ﻓﻲ اﻟﺘﻌﺮض ﻓﻲ أﻟﻔﻮزوﺳﯿﻦ‬  ‫اﻷﻧﺪروﺟﯿﻦ اﻷﺳﺎﺳﻲ اﻟﻤﺴﺆول ﻋﻦ ﺗﻄﻮر‬ ‫وﺗﻄﻮر ﺗﻀﺨﻢ ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ ھﻮ‬ 5α- ‫ ھﻨﺎك إﻧﺰﯾﻤﺎن ﻣﺘﺠﺎﻧﺴﺎن ﻣﻦ‬.DHT 5α-Reductase inhibitors ‫ ﻓﻲ ﻣﻌﻈﻢ‬1 ‫ ﯾﻮﺟﺪ اﻟﻨﻮع‬:reductase ‫ ﻣﺜﻞ اﻟﻜﺒﺪ‬5α ‫اﻷﻧﺴﺠﺔ اﻟﻤﻨﺘﺠﺔ ﻟﻼﺧﺘﺰال‬ ‫ ﺳﺎﺋﺪ ﻓﻲ اﻷﻧﺴﺠﺔ‬2 ‫واﻟﺠﻠﺪ واﻟﺸﻌﺮ؛ اﻟﻨﻮع‬.‫ ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬،‫اﻟﺘﻨﺎﺳﻠﯿﺔ‬  The primary androgen responsible for the development and progression of BPH is DHT. There are two isoenzymes of 5α-reductase: type 1 is found in most 5α-reductase producing tissues such as the liver, skin and hair; type 2 is predominant in genital tissue, including the prostate.  5α-Reductase inhibitors down regulate prostate growth by blocking the conversion of testosterone to the more potent DHT..‫ اﻷﻛﺜﺮ ﻗﻮة‬DHT ‫ ﻧﻤﻮ اﻟﺒﺮوﺳﺘﺎﺗﺎ ﻋﻦ طﺮﯾﻖ ﻣﻨﻊ ﺗﺤﻮﯾﻞ اﻟﺘﺴﺘﻮﺳﺘﯿﺮون إﻟﻰ‬5α-Reductase ‫ﺗﻨﻈﻢ ﻣﺜﺒﻄﺎت‬  The two agents currently available in this group are finasteride and dutasteride..‫اﻟﻌﺎﻣﻼن اﻟﻤﺘﻮﻓﺮان ﺣﺎﻟﯿﺎ ﻓﻲ ھﺬه اﻟﻤﺠﻤﻮﻋﺔ ھﻤﺎ ﻓﯿﻨﺎﺳﺘﺮاﯾﺪ ودوﺗﺎﺳﺘﯿﺮﯾﺪي‬  Both have been shown to reduce prostate volume, to improve symptom scores and flow rates, and reduce the incidence of complications such as acute urinary retention (AUR) and the need for surgical intervention to treat BPH.‫ﺣﺪوث‬ ‫ وﺗﻘﻠﯿﻞ‬،‫ ﻟﺘﺤﺴﯿﻦ درﺟﺎت اﻷﻋﺮاض وﻣﻌﺪﻻت اﻟﺘﺪﻓﻖ‬،‫ﻟﻘﺪ ﺛﺒﺖ أن ﻛﻼھﻤﺎ ﯾﻘﻠﻞ ﻣﻦ ﺣﺠﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬.‫( واﻟﺤﺎﺟﺔ إﻟﻰ اﻟﺘﺪﺧﻞ اﻟﺠﺮاﺣﻲ ﻟﻌﻼج ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﺪ‬AUR) ‫اﻟﻤﻀﺎﻋﻔﺎت ﻣﺜﻞ اﺣﺘﺒﺎس اﻟﺒﻮل اﻟﺤﺎد‬  Improvements in LUTSs are normally seen after the first 6 months of treatment and are sustained during continuous treatment ‫ ﺑﻌﺪ اﻷﺷﮭﺮ اﻟﺴﺘﺔ اﻷوﻟﻰ ﻣﻦ‬LUTSs ‫ﻋﺎدة ﻣﺎ ﺗﻈﮭﺮ اﻟﺘﺤﺴﯿﻨﺎت ﻓﻲ‬ ‫اﻟﻌﻼج وﯾﺘﻢ اﻟﺤﻔﺎظ ﻋﻠﯿﮭﺎ أﺛﻨﺎء اﻟﻌﻼج اﻟﻤﺴﺘﻤﺮ‬ Finasteride.  Finasteride is a type 2, 5α-reductase inhibitor that can reduce prostate size by about 30%, improve symptom scores and increase urinary flow..‫ وﯾﺤﺴﻦ درﺟﺎت اﻷﻋﺮاض وﯾﺰﯾﺪ ﻣﻦ ﺗﺪﻓﻖ اﻟﺒﻮل‬،٪30 ‫ ﯾﻤﻜﻦ أن ﯾﻘﻠﻞ ﻣﻦ ﺣﺠﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ ﺑﻨﺤﻮ‬5α ،2 ‫ﻓﯿﻨﺎﺳﺘﺮاﯾﺪ ھﻮ ﻣﺜﺒﻂ اﺧﺘﺰال ﻣﻦ اﻟﻨﻮع‬  Those most likely to benefit are men with a prostate larger than 40mL. ‫ﯾﻌﺎﻧﻮن‬ ‫أوﻟﺌﻚ اﻟﺬﯾﻦ ﻣﻦ اﻟﻤﺮﺟﺢ أن ﯾﺴﺘﻔﯿﺪوا ھﻢ اﻟﺮﺟﺎل اﻟﺬﯾﻦ‬.‫ ﻣﻞ‬40 ‫ﻣﻦ اﻟﺒﺮوﺳﺘﺎﺗﺎ أﻛﺒﺮ ﻣﻦ‬  Side effects include decreased libido, impotence, reduced ejaculatory volume and, less commonly, gynaecomastia and breast tenderness..‫ اﻟﺘﺜﺪي وﺣﻨﺎن اﻟﺜﺪي‬،‫ وأﻗﻞ ﺷﯿﻮﻋﺎ‬،‫ﺗﺸﻤﻞ اﻵﺛﺎر اﻟﺠﺎﻧﺒﯿﺔ اﻧﺨﻔﺎض اﻟﺮﻏﺒﺔ اﻟﺠﻨﺴﯿﺔ واﻟﻌﺠﺰ اﻟﺠﻨﺴﻲ واﻧﺨﻔﺎض ﺣﺠﻢ اﻟﻘﺬف‬  Combination therapy  It is well established that α-adrenoceptor antagonists are best for managing acute symptoms but have no impact on reducing the risk of complications such as AUR or progression to prostate surgery. ‫ ھﻲ اﻷﻓﻀﻞ ﻹدارة اﻷﻋﺮاض اﻟﺤﺎدة وﻟﻜﻦ ﻟﯿﺲ‬α-adrenore ‫ﻣﻦ اﻟﺜﺎﺑﺖ أن ﻣﻀﺎدات ﻣﺴﺘﻘﺒﻼت‬.‫ أو اﻟﺘﻘﺪم إﻟﻰ ﺟﺮاﺣﺔ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬AUR ‫ﻟﮭﺎ أي ﺗﺄﺛﯿﺮ ﻋﻠﻰ اﻟﺤﺪ ﻣﻦ ﺧﻄﺮ ﺣﺪوث ﻣﻀﺎﻋﻔﺎت ﻣﺜﻞ‬  In contrast, 5α-reducatase inhibitors have little impact on short-term acute symptoms but reduce prostate size, improve urinary flow and obstructive symptoms in the long- term. ‫ ﻟﮭﺎ ﺗﺄﺛﯿﺮ ﺿﺌﯿﻞ ﻋﻠﻰ اﻷﻋﺮاض اﻟﺤﺎدة ﻋﻠﻰ اﻟﻤﺪى اﻟﻘﺼﯿﺮ‬5α-reducatase ‫ ﻓﺈن ﻣﺜﺒﻄﺎت‬،‫ﻋﻠﻰ اﻟﻨﻘﯿﺾ ﻣﻦ ذﻟﻚ‬.‫ وﺗﺤﺴﻦ اﻟﺘﺪﻓﻖ اﻟﺒﻮﻟﻲ واﻷﻋﺮاض اﻻﻧﺴﺪادﯾﺔ ﻋﻠﻰ اﻟﻤﺪى اﻟﻄﻮﯾﻞ‬،‫وﻟﻜﻨﮭﺎ ﺗﻘﻠﻞ ﻣﻦ ﺣﺠﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬  Furthermore, α-adrenoceptor antagonists are effective regardless of prostate volume, whereas the 5α-reductase inhibitors are more suited for the management of LUTSs in men with large prostates. ‫ ﻓﻲ ﺣﯿﻦ أن‬،‫ ﻓﺈن ﻣﻀﺎدات ﻣﺴﺘﻘﺒﻼت اﻷدرﯾﻨﺎﻟﯿﺔ ﻓﻌﺎﻟﺔ ﺑﻐﺾ اﻟﻨﻈﺮ ﻋﻦ ﺣﺠﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬،‫ﻋﻼوة ﻋﻠﻰ ذﻟﻚ‬.‫ ﻟﺪى اﻟﺮﺟﺎل اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﻜﺒﯿﺮة‬LUTSs ‫ أﻛﺜﺮ ﻣﻼءﻣﺔ ﻹدارة‬5α ‫ﻣﺜﺒﻄﺎت اﺧﺘﺰال‬  In terms of long-term benefits, continued treatment with 5α- reductase inhibitors decreases the risk of AUR and BPH- 5 ‫ ﻳﻘﻠﻞ اﻟﻌﻞاج اﻟﻤﺴﺘﻤﺮ ﺑﻤﺜﺒﻄﺎت‬،‫ﻣﻦ ﺣﻴﺚ اﻟﻔﻮاﺋﺪ ﻃﻮﻳﻠﺔ الأﺟﻞ‬αreductase ‫ﻣﻦ ﺧﻄﺮ اﻟﺠﺮاﺣﺔ اﻟﻤﺮﺗﺒﻄﺔ‬ related surgery. ‫ ب‬AUR ‫ و‬BPH..‫ ﻹدارة اﻷﻋﺮاض اﻟﺤﺎدة وﺗﻘﻠﯿﻞ ﺗﻄﻮر ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ‬5α ‫ ﯾﺒﺪو ﻣﻦ اﻟﻤﻨﻄﻘﻲ اﺳﺘﺨﺪام ﻣﺰﯾﺞ ﻣﻦ ﻣﻀﺎدات ﻣﺴﺘﻘﺒﻼت اﻷدرﯾﻨﺎﻟﯿﺔ وﻣﺜﺒﻂ اﺧﺘﺰال‬،‫ﻟﺬﻟﻚ‬  Therefore, it appears logical to use a combination of an α- adrenoceptor antagonist and a 5α-reductase inhibitor to manage acute symptoms and reduce progression of BPH.  The combination was also found to reduce AUR and progression to BPH-related surgery and, although superior to tamsulosin with respect to these complications, combination therapy was ‫ واﻟﺘﻘﺪم إﻟﻰ اﻟﺠﺮاﺣﺔ اﻟﻤﺮﺗﺒﻄﺔ ﺑﺘﻀﺨﻢ‬AUR ‫وﺟﺪ أﯾﻀﺎ أن اﻟﺘﺮﻛﯿﺒﺔ ﺗﻘﻠﻞ ﻣﻦ‬ not better than dutasteride. ‫ﺑﮭﺬه‬ ‫ وﻋﻠﻰ اﻟﺮﻏﻢ ﻣﻦ أﻧﮫ ﻣﺘﻔﻮق ﻋﻠﻰ ﺗﺎﻣﺴﻮﻟﻮﺳﯿﻦ ﻓﯿﻤﺎ ﯾﺘﻌﻠﻖ‬،‫اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ‬.‫ إﻻ أن اﻟﻌﻼج اﻟﻤﺮﻛﺐ ﻟﻢ ﯾﻜﻦ أﻓﻀﻞ ﻣﻦ دوﺗﺎﺳﺘﯿﺮﯾﺪي‬،‫اﻟﻤﻀﺎﻋﻔﺎت‬  Overall, the adverse events associated with combination therapy were few and treatment was well tolerated..‫ ﻛﺎﻧﺖ اﻷﺣﺪاث اﻟﺴﻠﺒﯿﺔ اﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﻌﻼج اﻟﻤﺮﻛﺐ ﻗﻠﯿﻠﺔ وﻛﺎن اﻟﻌﻼج ﺟﯿﺪ اﻟﺘﺤﻤﻞ‬،‫ﺑﺸﻜﻞ ﻋﺎم‬  Combination therapy with an α-adrenoceptor antagonist and a 5α-reductase inhibitor has now been adopted widely into routine practice for the early management of LUTSs and to reduce progression of BPH. ‫اﻟﺮوﺗﯿﻨﯿﺔ‬ ‫ﺗﻢ اﻵن اﻋﺘﻤﺎد اﻟﻌﻼج اﻟﻤﺮﻛﺐ ﻣﻊ ﻣﻀﺎد ﻣﺴﺘﻘﺒﻼت أﻟﻔﺎ اﻷدرﯾﻨﺎﻟﯿﺔ‬ ‫ ﻋﻠﻰ ﻧﻄﺎق واﺳﻊ ﻓﻲ اﻟﻤﻤﺎرﺳﺔ‬5α ‫وﻣﺜﺒﻂ اﺧﺘﺰال‬ ‫ وﻟﻠﺤﺪ ﻣﻦ ﺗﻄﻮر ﺗﻀﺨﻢ اﻟﺒﺮوﺳﺘﺎﺗﺎ‬LUTSs ‫ﻟﻺدارة اﻟﻤﺒﻜﺮة ل‬.‫اﻟﺤﻤﯿﺪ‬   Surgical treatments  Surgical interventions are commonly performed in men with LUTSs caused by BPH that have failed to respond to medical treatment. ‫ اﻟﻨﺎﺟﻤﺔ ﻋﻦ ﺗﻀﺨﻢ‬LUTSs ‫ﻋﺎدة ﻣﺎ ﯾﺘﻢ إﺟﺮاء اﻟﺘﺪﺧﻼت اﻟﺠﺮاﺣﯿﺔ ﻓﻲ اﻟﺮﺟﺎل اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ‬.‫اﻟﺒﺮوﺳﺘﺎﺗﺎ اﻟﺤﻤﯿﺪ اﻟﺬي ﻓﺸﻞ ﻓﻲ اﻻﺳﺘﺠﺎﺑﺔ ﻟﻠﻌﻼج اﻟﻄﺒﻲ‬  Surgery is also indicated in patients who develop complications such as intractable or recurrent urinary retention, renal impairment, persistent haematuria, recurrent UTIs or bladder stones ،‫اﻟﻤﺘﻜﺮر‬ ‫ﯾﺸﺎر إﻟﻰ اﻟﺠﺮاﺣﺔ أﯾﻀﺎ ﻓﻲ اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﯾﺼﺎﺑﻮن ﺑﻤﻀﺎﻋﻔﺎت ﻣﺜﻞ اﺣﺘﺒﺎس اﻟﺒﻮل اﻟﻤﺴﺘﻌﺼﻲ أو‬ ‫ واﻟﺘﮭﺎﺑﺎت اﻟﻤﺴﺎﻟﻚ اﻟﺒﻮﻟﯿﺔ اﻟﻤﺘﻜﺮرة أو ﺣﺼﻰ اﻟﻤﺜﺎﻧﺔ‬،‫ واﻟﺒﯿﻠﺔ اﻟﺪﻣﻮﯾﺔ اﻟﻤﺴﺘﻤﺮة‬،‫واﻟﻀﻌﻒ اﻟﻜﻠﻮي‬ THANK YOU